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These Lifestyle Habits May Increase Your Chances of Having brain stroke

by Pragati Singh
written by Pragati Singh

Brain strokes pose a serious threat to individuals, and some of our lifestyle choices invite this medical emergency. Before we get into what these lifestyle habits are, it’s important to understand what a brain stroke is. A stroke is a serious condition that occurs when the blood supply to one or more parts of the brain is disrupted. Because of the interruption or delay in blood supply, brain tissue does not receive oxygen and nutrients, resulting in a stroke.

From unhealthy eating to excessive smoking, there are many lifestyle choices that can increase your chances of experiencing a stroke. Researchers at John Hopkins Medicine reveal that taking contraceptive pills can also increase one’s risk of encountering a stroke. The combined oral contraceptive pill and contraceptive patch have the hormone oestrogen, which increases the risk of stroke. The research has highlighted a couple of lifestyle habits that lead to brain stroke:

No Physical Activity

With work from home in place, physical activity has been restricted a lot more. Being inactive with no movement can only make you obese, further inviting a series of major illness. It makes your vulnerable to chronic conditions and increases the risk of strokes. Regular exercise and eating healthy can protect you from all sorts of life-threatening conditions and complications, one as brain stroke.

Smoking

Apart from making your heart health and respiratory functions poor, cigarette smoking makes an individual more prone to strokes. Experts at John Hopkins Medicine have stated that smoking almost doubles the risk for an ischemic stroke.

Binge Drinking

The researchers condemn binge drinking as it can lead to stroke. It is said that more than two drinks per day raises your blood pressure. As per National Health Services (NHS)’s definition, binge drinking refers to drinking lots of alcohol in a short space of time or drinking to get drunk. While for men, 8 units of alcohol in a single session is termed as binge drinking, for women, it is six units.

Medical conditions

Individuals with medical conditions such as diabetes, high cholesterol, hypertension, Atrial Fibrillation (AF) are at a higher risk of suffering a stroke. However, these are all controllable risk factors, but family history, age, gender are uncontrollable risk factors.

How is a brain stroke treated?

One needs to act immediately if they see someone suffering with a stroke. In order to treat an ischemic stroke, doctors are advised to quickly restore the blood flow to the brain. However, in case of a hemorrhagic stroke, surgery could be recommended.

 

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Mental healthNeurology News

A brain implant may be able to alleviate the most severe depression

by Vaishali Sharma
written by Vaishali Sharma

After promising results with a first patient, US scientists believe an electrical implant that sits in the skull and is wired to the brain can detect and treat severe depression.Sarah, 36, had the device implanted more than a year ago and claims it has changed her life.

 

The matchbox-sized pack in her head is always “on,” but it only sends out an impulse when it senses she might need it.The experimental study is described in the journal Nature Medicine.

 

The researchers from the University of California, San Francisco, emphasise that it is too early to say whether it will help other patients with difficult-to-treat depression, such as Sarah, but they are optimistic and plan more trials.

 

Cicuits of depression :

Sarah is the first person to receive the experimental treatment.

 

She’d had a string of failed treatments in recent years, including antidepressants and electroconvulsive therapy.

The surgery may sound daunting, but Sarah said the prospect of gaining “any kind of relief” was better than the darkness she had been experiencing.

“I had exhausted all possible treatment options. “My daily life had become so restricted. I felt tortured each day. I barely moved or did anything.”

The surgery involved drilling small holes in her skull to fit the wires that would monitor and stimulate her brain.

 

How It Works

Dr. Katherine Scangos, a psychiatrist at the university, explained that the breakthrough was made possible by locating the “depression circuits” in Sarah’s brain.

“We discovered one area, known as the ventral striatum, where stimulation consistently eliminated her feelings of depression.”

“We also discovered a brain activity area in the amygdala that could predict when her symptoms were at their worst.”

According to the researchers, much more research is needed to put the experimental therapy to the test and see if it can help more people suffering from severe depression, as well as other conditions.

 

Individualized care

Dr. Scangos, who has two other patients enrolled in the trial and hopes to recruit nine more, stated: “We need to look at how these circuits differ between patients and repeat this work several times.

“And we need to see if a person’s biomarker or brain circuit changes over time as the treatment progresses.

“We weren’t sure if we’d be able to treat her depression at all because it was so severe.

“As a result, we are very excited about this. It’s desperately needed in the field right now.”

According to Dr. Edward Chang, the neurosurgeon who installed the device: “To be clear, this is not a demonstration of the effectiveness of this method.

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Neurology News

Lifestyle Choices for Brain Health

by Renu Vohra
written by Renu Vohra

Article Compiled by Renu Vohra , Member Secretary , Alzheimer’s Related Disorders Society of India (Delhi Chapter) 

Living a brain healthy lifestyle is particularly important once you reach middle age, as this is the time when changes in the brain start to occur. They may start decades before symptoms appear. This means that it is important to look after the brain throughout your life. It is never too late or too early to bring lifestyle changes as brain function can be improved at any age.

 

Exercise your brain:

Any activity that involves thinking, learning and active networking regularly challenges your brain. These stimulating activities can improve your brain health.

The best activities are those that you enjoy.

Hobbies like painting, woodwork , sewing, knitting and writing provide stimulus to the brain.

Doing jigsaw puzzles, crossword , suduko, chess , card games learning to dance , playing an instrument, learning a new language challenge the brain.

Regular and enjoyable interaction with friends like travelling , volunteering with a local charity, walking with friends and family, joining a book club, catching up with friends and talking to your neighbours is active networking which is beneficial to the brain. Passive networking such as Whattsapp or Facebook do not give such benefits.

Physical exercise is neuro-protective:

Regular physical exercise can reduce the risk of Dementia. It can also slow down further deterioration in those who are showing early symptoms of Dementia.

Exercise for 30 mins, walk, jog, cycle,hike,swim or join a dance group….. not gyming !!

To avoid risk of fall balance and coordination exercises can help you stay agile. Exercises like Yoga , Pilates, Tai chi go a long way to improve balance and coordination and avoid fall or head injury.

You can also introduce exercise in your daily routine by taking some simple steps. Walk while you are on your mobile phone, take stairs instead of lift. If you have to work for long hours while sitting on a desk, take frequent breaks and walk around or stand up for a couple of minutes.

Some of the offices are providing standing work stations in the place of work and conference rooms. Opt for that option if available , or request for that healthy change in your work place.

The human brain is an organ which improves through mental stimulation. It continues to adapt, grow and rewire itself through the growth of new neurons.

Using your non-dominant hand to write, use is to control computer mouse, television remote, brushing your teeth, opening doors etc will strengthen neural connections.

Exercise also improves body posture . Walking with a hunch slows down your gait is associated with increase risk of Dementia.

There is clear evidence that physical exercise helps in sprouting of neurons to prevent neuro-generative disease like Alzheimer’s.

Healthy Diet:

The foods we eat can have a big impact on the structure and health of our brains. Eating a brain-boosting diet can support both short- and long-term brain functions.

Indian home cooked diet of Roti ,dal ,legumes vegetables , salads ( washed well) is good for brain health. Red meats, beef , pork and chicken should be limited in your daily intake.

Fish could be included in your diet but make sure it is not bred in toxic waters with high content of mercury.

All Vegetables and fruits of different colours like capsicum, green, yellow and red, cabbage , green leafy vegetables , zucchini , cauliflower, kale, carrots , brocolli ( it has glutathione a very powerful antioxidant, which prevents memory decline) and fruits like apples guava, mangoes, pears, grapes bananas etc should be included in our diet regularly.

Antioxidant-rich berries that can boost brain health:

Include strawberries,

blackberries,blueberries

blackcurrants and mulberries in your diet.

Eating more nuts and seeds may be good for the brain, as these foods contain omega-3 fatty acids and antioxidants and healthful unsaturated fats .

Walnuts and Brazil nuts, cashews, almonds and peanuts can give you protection against chronic diseases.

Sunflower seeds,flaxseed and chia seeds also reduces the risk of Alzheimer’s disease.

Eggs are a source of

vitamin B-6, vitamin B-12

and folic acid.

Recent research suggests that these vitamins may prevent brain shrinkage and delay cognitive decline.

Yoghurt :

Yoghurt contain beneficial bacteria known as probiotics. These bacteria stimulates the Vagus nerve, and that, in turn stimulates the production of various neurotransmitters , which get depleted under stress.

Turmeric:

Turmeric is a super spice. It contains Curcumin a natural anti- inflammatory compound and a potent antioxidant. It keeps the memory sharp, boosts the brain and helps it to heal.

Healthy oils:

Include healthy oils in your diets such as mustard oil , peanut oil,sunflower oil , soyabean oil, olive oil and a small amount of Ghee.

Palm oil is unhealthy and is used mostly in bakery products like cakes, biscuits , sweets etc. Also these processed food have high sugar and salt content which is unhealthy as it promotes obesity , diabetes and high cholesterol which is toxic to brain and body .

Avoid snacking on junk food, sugary drinks, sweets and inculcate this habit in children as it will provide many benefits to them in their mid life and beyond in protecting their brain health.

Sleep Deprivation:

Sleep is absolutely essential for good mental health. Sleep is not a passive but active function of the brain.

In the daytime we all make Beta amyloid proteins in the brain. During sleep the brain cells known as glymphatics enlarge and pulsate to remove toxins from the brain. Due to lack of sleep the brain does not have enough time to drain beta amyloids and other neuro toxic waste . These substances continue to accumulate day after day in form of plaques and tangles in the brain, which is the main cause of Alzheimer’s disease .

Harmful effects of inadequate sleep can start at the age of 50 if not earlier. It is essential to have 6-8 hours of sleep. Avoid sleeping pills as it does not give you the deep sleep required for memory consolidation in the permanent memory centres of brain.

Quit Smoking:

Smoking or inhaling of tobacco smoke or passive smoking has been linked to oxidative stress. Due to this the risk of Alzheimer’s/ Dementia becomes significantly higher.

Brain uses 20% of body oxygen supply from the blood. Smoking damages the structures of blood vessels making it harder for the blood to flow freely around body and brain. Due to this the brain is deprived of oxygen rich blood supply and the brain cells do not get adequate nutrients to survive, thrive and resist damage.

Alcohol in moderation.

Long term exposure to excessive alcohol can shrink the brain. It can change a person’s typical behaviour without mental clarity , interfere with his or her long term memory and may cause hallucinations. All these factors can substantially increase the risk of developing Alzheimer’s/ Dementia.

Laughter is the best medicine:

Laughter triggers the release of endorphins, the body’s natural feel good chemicals. Endorphins promote overall sense of well-being and

de-stress the brain.

So how do we bring more laughter in our lives?

Practice smiling at someone like your coworkers or someone you meet regularly in the lift or bus. You will notice that smile like laughter is contagious.

When you hear laughter move towards it. Spend time with playful friends. Join a laughter club.

Learn to laugh at yourself to make an embarrassing moment funny. Put up a funny poster in your home or office. Choose a computer screen saver which makes you laugh. You may think of countless other ways of humour to improve the brain health.

Laughter is also as effective as antipsychotic medications for reducing anxiety in the elderly people with Dementia.

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Experts speakMental healthNeurology News

Challenges in Dementia care during Covid-19 pandemic

by Renu Vohra
written by Renu Vohra

Covid-19 pandemic has presented unprecedented threat especially to the elderly suffering from neurological disorders like Alzheimer’s.

There is an additional burden of stigma, abuse, ageism, financial impoverishment, loneliness attached to dementia.

Disruption of nonessential healthcare services like closure of Daycare centre due to fear of infection affected the treatment and care of the Alzheimer’s patients. A delay of few weeks to months may prove critical for people living with dementia. Especially an early diagnosis window of opportunity is lost.

Persons living with Dementia find it harder to comply with social distancing, usage of mask, gloves or sanitisation. The difficulty in comprehension of the above information manifests as agitation,restlessness, aggression and other problematic behavioural symptoms. Some older adults with dementia are often frail, with impaired mobility, respiratory reflexes are at a high risk of infection and mortality. As a result the caregivers role has become more challenging as dementia patients may not learn properly the use personal protection elements, such as wearing facial masks, washing hands, and keeping social distance and complying with other safeguarding procedures .

These patients are likely to experience additional distress owing to absence of relatives, friends and neighbours who would normally visit them. There is also a strict limitations of social activities such as going for a walk, visit to a place of worship, going for a holiday or shopping which they did on regular basis.This social isolation is linked to more confusion in the patients with Dementia and may result in greater agitation and aggression as well as other unexplained behaviour.

Before pandemic engaging in social activities, preforming cognitive and physical activities and having productive daily routine had been the mainstay therapy. But now and during Pandemic lockdown all that reversed and strict social isolation had to be observed along with other quarantine guidelines.

We encourage providing interaction with loved ones, friends and pets on digital services like zoom, FaceTime to the people living with dementia. Also most religious places are zooming their daily prayer services on digital platforms like YouTube which can be easily watched at their convenience. All the above activities increases the “contact time” for people living with dementia. This will help in improving the behaviour issues in the patient and reducing the stress on the caregivers.

As a precaution Vaccinations for all Dementia patients, their prime caregivers as well as family members is recommended. This would give them a good protection from infection.

Visitors to the patient should also be vaccinated.

They should be wearing a mask for the entire duration of the visit. The place where the visitation is held should be well ventilated preferably outdoors.

If the visitor has been exposed to anyone with the virus prior to 14 days , then postpone the visit.

Inform the family member immediately if the visitor develops a fever or symptoms consistent with Covid 19 within 14 days of the visit.

Check the temperature of the visitor or the caregiver before they enter the home. Ensure that they wash their hands upon arrival and regularly throughout the time they are with the patient.

The caregivers as well as the visitors should be made aware that information delivery to people living with dementia must be preformed slowly with frequent pauses, in short simple sentences preferably with the use of audio visual aids.

During highly contagious stage of pandemic we advise the family that there is always a possibility that the caregiver might himself/ herself get infected with the pandemic and is unable to provide required support. Alternate sources of care including friends, relatives or volunteers need to be planned and prepared in advance.

Since Dementia care in India is delivered mostly by informal caregivers usually family and women ( wife, daughter, daughter in law, sister) there is an increased burnout strain on them during pandemic due to higher dependency needs.

During and after the pandemic caregiver support is essential. Our team of counsellors at Alzheimer’s Related Disorders Society of India -Delhi Chapter have continuously provided that extra support to the families of dementia patients through

tele- counselling and video consultation.

We wish to resume our Day care services as early as possible with due precautions and integration with tele- medication to reduce the delay in early diagnosis and care.

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Mental healthNeurology News

A new study reveals that the ‘feel good’ brain messenger can be willfully controlled

by Pragati Singh
written by Pragati Singh

The neurological messenger known as dopamine has been popularly described as the brain’s “feel good” chemical related to reward and pleasure, from the thrill of hearing an ice cream truck approaching to the spikes of pleasure while sipping a fine wine.

A ubiquitous neurotransmitter that carries signals between brain cells, dopamine, among its many functions, is involved in multiple aspects of cognitive processing. The chemical messenger has been extensively studied from the perspective of external cues, or “deterministic” signals. Instead, University of California San Diego researchers recently set out to investigate less understood aspects related to spontaneous impulses of dopamine. Their results, published July 23 in the journal Current Biology, have shown that mice can willfully manipulate these random dopamine pulses.

Rather than only occurring when presented with pleasurable, or reward-based expectations, UC San Diego graduate student Conrad Foo led research that found that the neocortex in mice is flooded with unpredictable impulses of dopamine that occur approximately once per minute.

Working with colleagues at UC San Diego (Department of Physics and Section of Neurobiology) and the Icahn School of Medicine at Mount Sinai in New York, Foo investigated whether mice are in fact aware that these impulses — documented in the lab through molecular and optical imaging techniques — are actually occurring. The researchers devised a feedback scheme in which mice on a treadmill received a reward if they showed they were able to control the impromptu dopamine signals. Not only were mice aware of these dopamine impulses, the data revealed, but the results confirmed that they learned to anticipate and volitionally act upon a portion of them.

“Critically, mice learned to reliably elicit (dopamine) impulses prior to receiving a reward,” the researchers note in the paper. “These effects reversed when the reward was removed. We posit that spontaneous dopamine impulses may serve as a salient cognitive event in behavioral planning.”

The researchers say the study opens a new dimension in the study of dopamine and brain dynamics. They now intend to extend this research to explore if and how unpredictable dopamine events drive foraging, which is an essential aspect of seeking sustenance, finding a mate and as a social behavior in colonizing new home bases.

“We further conjecture that an animal’s sense of spontaneous dopamine impulses may motivate it to search and forage in the absence of known reward-predictive stimuli,” the researchers noted.

In their efforts to control dopamine, the researchers clarified that dopamine appears to invigorate, rather than initiate, motor behavior.

“This started as a serendipitous finding by a talented, and curious, graduate student with intellectual support from a wonderful group of colleagues,” said study senior co-author David Kleinfeld, a professor in the Department of Physics (Division of Physical Sciences) and Section of Neurobiology (Division of Biological Sciences). “As an unanticipated result, we spent many long days expanding on the original study and of course performing control experiments to verify the claims. These led to the current conclusions.”

The full authors list of the paper includes: Conrad Foo, Adrian Lozada, Johnatan Aljadeff, Yulong Li, Jing W. Wang, Paul A. Slesinger and David Kleinfeld.

Source: University of California – San Diego

 

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Neurology News

Gene therapy in early stages of Huntington’s disease may slow down symptom progression

by Vaishali Sharma
written by Vaishali Sharma

Source: Johns Hopkins Medicine

In a new study on mice, Johns Hopkins Medicine researchers report that using MRI scans to measure blood volume in the brain can serve as a noninvasive way to potentially track the progress of gene editing therapies for early-stage Huntington’s disease, a neurodegenerative disorder that attacks brain cells. The researchers say that by identifying and treating the mutation known to cause Huntington’s disease with this type of gene therapy, before a patient starts showing symptoms, it may slow progression of the disease.

The findings of the study were published May 27 in the journal Brain.

“What’s exciting about this study is the opportunity to identify a reliable biomarker that can track the potential success of genetic therapies before patients start manifesting symptoms,” says Wenzhen Duan, M.D., Ph.D., director of the translational neurobiology laboratory and professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. “Such a biomarker could facilitate the development of new treatments, and help us determine the best time to begin them.”

Huntington’s disease is a rare genetic disorder caused by a single defective gene, dubbed “huntingtin,” on human chromosome 4. The gene is passed on from parents to children — if one parent has the mutation, each child has a 50% chance of inheriting it. Huntington’s disease has no cure and can lead to emotional disturbances, loss of intellectual abilities and uncontrolled movements. Thanks to genetic testing, people can know if they have the disease long before symptoms arise, which typically happens in their 40s or 50s.

For the study, Duan and her team collaborated with colleagues from Kennedy Krieger Institute in Baltimore, Maryland, who developed a novel method to more precisely measure the blood volume in the brain by using advanced functional MRI scans. With the scans, they can map the trajectory of blood flow in small blood vessels called arterioles in the brains of mice engineered to carry the human huntingtin gene mutation that mirror the early stages of Huntington’s disease in humans.

Duan notes that there are many known metabolic changes in the brains of people with Huntington’s disease, and those changes initiate a brain blood volume response in the disease’s early stages. Blood volume is a key marker for oxygen supply to brain cells, which in turn supplies energy for the neurons to function. But with Huntington’s disease, the brain’s arteriolar blood volume is dramatically diminished, which makes the neurons deteriorate because of lack of oxygen as the disease progresses.

In a series of experiments, the researchers suppressed the mutation in the huntingtin gene in mice, using a gene-editing technology known as CRISPR — a tool for editing genomes that allows the alteration of a DNA sequence to modify gene function. Then, they used the MRI scanning technique and other tests to track the brain function over time both of mice with the huntingtin mutation, in which they edited out the faulty gene sequence, and a control group of mice in which the faulty gene was unedited.

The experiments assessed abnormalities in the trajectory of arteriolar blood volumes in mouse brains with the Huntington’s disease mutation at 3, 6 and 9 months of age (pre-symptom stage, beginning of symptoms and post-symptom stage, respectively). The researchers looked at whether suppression of the mutant huntingtin gene in the neurons could normalize altered arteriolar blood volumes in the pre-symptom stage, and whether reduced expression of the huntingtin gene at the pre-symptom stage could delay or even prevent development of symptoms.

“Overall, our data suggest that the cerebral arteriolar blood volume measure may be a promising noninvasive biomarker for testing new therapies in patients with Huntington’s who are yet to show symptoms of the disease,” says Duan. “Introducing treatment in this early stage may have long-lasting benefits.”

When the researchers mapped the trajectory of cerebral blood volume and conducted an assortment of brain and motor tests in the mice at 3 months of age, and compared the test to those of the control group, they observed no significant differences except in cerebral blood volumes. However, Huntington’s symptoms in the mice with the huntingtin gene started at 6 months of age and progressively worsened at 9 months, suggesting that altered cerebral blood volume occurs before motor symptoms and atrophy of the brain cells — typical traits of the disease.

The cerebral blood volume changes were also found to be similar to those observed in patients with Huntington’s disease before they start manifesting symptoms, which declines with the start of symptoms and while the disease progresses over time.

The researchers also analyzed the structure of the arteriole blood vessels in the brains of mice with the mutant huntingtin gene at 3 and at 9 months of age and found no differences in the numbers of vessel segments in the pre-symptom stage. However, they observed that smaller blood vessels had an increased density and reduced diameter, which may be a vascular response to compensate for the impaired neuronal brain function. This might suggest, the researchers conclude, that impaired vascular structure leads to lowered arteriole blood volumes and possibly compromised ability to compensate for the loss in the symptom stage.

Considering that Huntington’s disease symptoms depend not only on brain cell loss but also on how neurons deteriorate, the researchers set out to determine if suppressing the huntingtin gene during the pre-symptom stage in mice could delay or even prevent disease progression. To do that, the researchers introduced the altered huntingtin gene to the neurons in mice at 2 months of age and evaluated the outcomes at 3 months of age (when no atrophy or motor deficits were present).

Remarkably, the researchers say, the cerebral arteriolar blood volume in mice with the altered huntingtin gene was This suggests that the altered cerebral blood volume during the pre-symptom stage in mice is most likely due to neuronal changes in either activity or metabolism.

“Our findings demonstrate that significant changes in arteriolar cerebral blood volumes occur before neurons start to degenerate and symptoms begin, further supporting the idea that altered cerebrovascular function is an early stage symptom in Huntington’s disease,” says Duan. She explains that these changes also indicate there’s a pre-symptom therapeutic window in which to test interventions. While no animal model replicates all the symptoms of human Huntington’s disease, this research offers an alternative system to study functional changes in the pre-symptom stage, she says.

Further validation of these findings in human clinical trials would facilitate development of efficient therapeutic interventions for patients with Huntington’s disease before they start developing symptoms. “The goal is to delay or even conceivably prevent the manifestation of Huntington’s disease altogether,” says Duan.

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Neurology News

World Tumor Day: All you need to know

by Vaishali Sharma
written by Vaishali Sharma

World brain tumour day is observed on 8th of June every year since 2000. This day first observed by German Brain Tumour Association (Deutsche Hirntumorhilfe e.V.). This is a non-profit organisation which raises public awareness and educates people about brain tumour. Malignant brain tumour is very common in Germany as more than 8,000 people suffer from these diseases only in Germany. More than 500 new cases are diagnosed with brain tumour everyday worldwide. Number of patients with tumours that cause brain metastases is even higher than that. This is the most common type of cancer among children.

The incidence and prevalence of brain tumour is growing in India. According to a study on childhood cancer, brain tumour is commonest in girls and even in both sexes in adults although there is some variation amongst states.

Government of India has introduced National Cancer Control Programme with the objectives of prevention, screening, early detection, diagnosis and treatment including palliative care in end stage. 

What is Brain Tumour?

Unnecessary growth of cells when body don’t require them is known as cancer. A brain tumour occurs when abnormal cells produce within any part of brain. There are two main types of tumours namely, malignant and benign tumours. 

Some Facts about Brain tumour

  • Brain tumour can occur at any age.
  • The exact cause of brain tumour is not clear.
  • The symptoms of brain tumour depend on their size, type, and location.
  • The most common type of primary brain tumour among adults are astrocytoma, meningioma, and oligodendroglioma.
  • The most common type of primary brain tumours in children are medulloblastoma, grade I or II astrocytoma, (or glioma) ependymoma, and brain stem glioma.
  • Family history and high dose X-rays are risk factors for brain tumour.
  • Brain tumours are diagnosed by the doctor based on the results of a medical history and physical examination and various specialized tests of the brain and nervous system.
  • Options for brain tumour treatment include surgery, radiation therapy, and chemotherapy or a combination of treatments.

Symptoms

Symptoms of a brain tumor can be general or specific. A general symptom is caused by the pressure of the tumor on the brain or spinal cord. Specific symptoms are caused when a specific part of the brain is not working well because of the tumor. For many people with a brain tumor, they were diagnosed when they went to the doctor after experiencing a problem, such as a headache or other changes.

General symptoms include:

  • Headaches, which may be severe and worsen with activity or in the early morning
  • Seizures. People may experience different types of seizures. Certain drugs can help prevent or control them. Motor seizures, also called convulsions, are sudden involuntary movements of a person’s muscles. The different types of seizures and what they look like are listed below:
    • Myoclonic
      • Single or multiple muscle twitches, jerks, spasms
    • Tonic-Clonic (Grand Mal)
      • Loss of consciousness and body tone, followed by twitching and relaxing muscles that are called contractions
      • Loss of control of body functions, such as loss of bladder control
      • May be a short 30-second period of no breathing and a person’s skin may turn a shade of blue, purple, gray, white, or green
      • After this type of seizure, a person may be sleepy and experience a headache, confusion, weakness, numbness, and sore muscles.
    • Sensory
      • Change in sensation, vision, smell, and/or hearing without losing consciousness
    • Complex partial
      • May cause a loss of awareness or a partial or total loss of consciousness
      • May be associated with repetitive, unintentional movements, such as twitching
  • Personality or memory changes
  • Nausea or vomiting
  • Fatigue
  • Drowsiness
  • Sleep problems
  • Memory problems
  • Changes in ability to walk or perform daily activities

Symptoms that may be specific to the location of the tumor include:

  • Pressure or headache near the tumor
  • Loss of balance and difficulty with fine motor skills is linked with a tumor in the cerebellum.
  • Changes in judgment, including loss of initiative, sluggishness, and muscle weakness or paralysis is associated with a tumor in the frontal lobe of the cerebrum.
  • Partial or complete loss of vision is caused by a tumor in the occipital lobe or temporal lobe of the cerebrum.
  • Changes in speech, hearing, memory, or emotional state, such as aggressiveness and problems understanding or retrieving words can develop from a tumor in the frontal and temporal lobe of the cerebrum.
  • Altered perception of touch or pressure, arm or leg weakness on 1 side of the body, or confusion with left and right sides of the body are linked to a tumor in the frontal or parietal lobe of the cerebrum.
  • Inability to look upward can be caused by a pineal gland tumor.
  • Lactation, which is the secretion of breast milk, and altered menstrual periods in women, and growth in hands and feet in adults are linked with a pituitary tumor.
  • Difficulty swallowing, facial weakness or numbness, or double vision is a symptom of a tumor in the brain stem.
  • Vision changes, including loss of part of the vision or double vision can be from a tumor in the temporal lobe, occipital lobe, or brain stem.

Treatment

  • Surgery
  • Minimally Invasive Scarless Brain Surgery
  • Radiation therapy
  • Radiosurgery
  • Chemotherapy
  • Targeted drug therapy

Drugs Approved for Brain Tumor

  • Afinitor (Everolimus)
  • Afinitor Disperz (Everolimus)
  • Avastin (Bevacizumab)
  • Bevacizumab
  • BiCNU (Carmustine)
  • Carmustine
  • Carmustine Implant
  • Danyelza (Naxitamab-gqgk)
  • Everolimus
  • Gliadel Wafer (Carmustine Implant)
  • Lomustine
  • Mvasi (Bevacizumab)
  • Naxitamab-gqgk
  • Temodar (Temozolomide)
  • Temozolomide
  • Zirabev (Bevacizumab)
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Neurology News

AI teams with fMRI to advance the state of deep brain stimulation

by Vaishali Sharma
written by Vaishali Sharma

Researchers have combined functional MRI with machine learning to guide deep brain stimulation (DBS) for patients with Parkinson’s disease.

The system hit 88% accuracy at optimizing stimulation settings, as confirmed by brain-response patterns on the neuroimaging as well as visibly observable symptom improvement in two separate sets of patients.

The project was conducted at the University of Toronto and is described in a study published May 24 in Nature Communications.

Neuroscientist Alexandre Boutet, PhD (candidate), neurosurgeon Andres Lozano, MD, and colleagues built their AI model on prospectively acquired fMRI data from 67 Parkinson’s patients.

They obtained the data during both optimal and suboptimal stimulation procedures.

The team came to the 88% accuracy finding by testing the system on 39 patients. In the process they demonstrated that fMRI brain responses to DBS in Parkinson’s patients “could represent an objective biomarker of clinical response. … Upon further validation with additional studies, these findings may open the door to functional imaging-assisted DBS programming.”

Offering a quick primer on DBS, Boutet and co-authors write:

Deep brain stimulation has become a standard of care therapy for movement disorders, particularly Parkinson’s disease, essential tremor and dystonia, and is being investigated in psychiatric and cognitive disorders including major depressive disorder and Alzheimer’s disease. DBS involves placing an electrode to deliver electrical stimulation within a dysfunctional neural circuit to suppress aberrant activity and/or drive an underactive network. Despite its recognized benefits, the therapeutic mechanism of action of DBS remains incompletely understood.

In the Toronto study, the patients included some who had previously benefited by deep brain stimulation and others for whom participation in the project represented a first time undergoing the therapy.

Boutet and co-authors suggest their fMRI/machine learning technique might serve as an objective clinical tool for programming DBS devices.

Poor programming, they point out, has been called out as a likely culprit in the failure of DBS to prove efficacious against clinical depression.

“Our results show that fMRI can rapidly define the optimal DBS in Parkinson’s patients,” they write. “Obtaining DBS-induced fMRI brain signatures associated with optimal clinical benefits will not only allow us to obtain a better understanding of the mechanism of action of DBS but could also facilitate individualized medicine for our patients and may represent a step toward the possibility of autonomous, closed-loop DBS programming.”

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Effects of Covid-19 on Mental Health
Mental healthNeurology News

Is stress from COVID pandemic resulting neurological complications in youth?

by Vaishali Sharma
written by Vaishali Sharma

Dr. Rajnish Kumar,  Sr. Consultant & Unit Head, Neurology, Paras Hospitals, Gurgaon

Neurological complications have emerged as a significant cause of morbidity and mortality in the ongoing COVID-19 pandemic. Beside respiratory insufficiency, many hospitalized patients exhibit neurological manifestations ranging from headache and loss of smell, to confusion and disabling strokes.Youth are at the receiving end because they are undergoing many stressful factors, including changes in job responsibilities, sick friends or family, fear of illness, and general uncertainty for the future. This along with the COVID-19 infection is also anticipated to take a toll on the nervous system in the long term.

COVID-19 wreaks havoc on our bodies, including our brain. The verdict is out whether the brain is directly infected or is responsive to body-wide inflammation. Infection with COVID-19 in hospitalized patients has been associated with altered mental status, seizures, and stroke. Even after the infection stabilizes and clears, residual symptoms remain in the form of persistent brain fog, dizziness, and headaches in so-called COVID long haulers.

Cognitive Impact

COVID-19 is most widely known to damage the respiratory system, but research has shown that the nervous system is also affected, which could have lasting neurological consequences. A study done at Northwestern Medicine Healthcare System showed that 42% of admitted COVID-19 patients presented neurological symptoms at the onset of the disease, and 82% showed neurological symptoms overall. Nearly 32% had cognitive dysfunction. While the causes of dysfunction vary, there is always the potential for long-term complications, as the brain damage observed in COVID-19 survivors has caused cognitive, behavioral, and psychological changes. Lack of oxygen and encephalitis, or swelling of the brain, seem to be two of the leading causes of this damage and could ultimately lead to stroke.

The dangerous side of these potential complications is that they are not always linked to the severity of the disease. Researchers in China evaluated patients that seemingly recovered from the virus and found that cognitive issues like difficulty in paying attention for long periods of time prevailed. In addition to causing serious daily complications, those that have had a stroke are at higher risk of developing dementia later in life.

Some researchers think the unbalanced immune system caused by reacting to the coronavirus may lead to autoimmune diseases, but it’s too early to tell. Anecdotal reports of other diseases and conditions that may be triggered by the immune system response to COVID-19 include para-infectious conditions that occur within days to a few weeks after infection:

  • Multi-system infammatory syndrome – which causes inflammation in the body’s blood vessels
  • Transverse myelitis – an inflammation of the spinal cord
  • Guillain-Barré sydrome (sometimes known as acute polyradiculoneuritis) – a rare neurological disorder which can range from brief weakness to nearly devastating paralysis, leaving the person unable to breathe independently
  • Dysautonomia – dysfunction of the autonomic nerve system, which is involved with functions such a breathing, heart rate, and temperature control
  • Acute disseminating encephalomyelitis (ADEM) – an attack on the protective myelin covering of nerve fibers in the brain and spinal cord
  • Acute necrotizing hemorrhagic encephalopathy – a rare type of brain disease that causes lesions in certain parts of the brain and bleeding (hemorrhage) that can cause tissue death (necrosis)
  • Facial nerve palsies (lack of function of a facial nerve) such as Bell’s Palsy
  • Parkinson’s disease-like symptoms have been reported in a few individuals who had no family history or early signs of the disease

Role of vaccination

Almost everyone should get the COVID-19 vaccination. It will help protect you from getting COVID-19. The vaccines are safe and effective and cannot give you the disease. Most side effects of the vaccine may feel like flu and are temporary and go away within a day or two. In early vaccine development, there were extremely rare reports of unexplained neurological illness following COVID-19 vaccination, but regulators found no evidence the vaccines caused the illness. The U.S. Food and Drug Administration (FDA) continues to investigate any report of adverse consequences of the vaccine and none have appeared as of yet. Consult your primary care doctor or specialist if you have concerns regarding any pre-existing known allergic or other severe reactions and vaccine safety. Scientists are studying the risk to benefit ratio of the vaccine in someone who previously developed Guillain Barré syndrome after a vaccination. The general sense is the COVID-19 vaccine is safe in individuals whose Guillain-Barré syndrome was not associated with a previous vaccination.

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Mucormycosis
Neurology News

Why Covid Patients Catch Black Fungus

by Vaishali Sharma
written by Vaishali Sharma

In Neurosurgery we come across a myriad of patients. Young and old, immunocompromised and diabetics. Across the board, worldwide, steroid is used for brain tumors and spinal cord injuries in high doses. Very rarely does one come across the black fungus. Then why has this fungus come into prominence during this Pandemic.

The answer lies in comparing the pathogenesis of the corona virus and black fungus. The covid infection is a vascular disease leading to damage of blood vessels. It damages the endothelium, causes vasoplegia, myocardial injury, ARDS and immune exhaustion. The blood vessels get clogged; the immune system is fatigued and exhausted following a hyper immune response. The treatment dictates use of steroids, antiviral and antibiotics. All these factors set the stage for inviting opportunistic fungal infection.

The black fungus accepts the open invitation. It freely floats’ as spores in the air we breathe. It gets lodged into the nasal passage of Covid patient (ideally a diabetic with uncontrolled blood sugars). If in keto acidosis, then still better, for the fungus, because the acidic environment helps it in getting more serum iron. This fungus requires iron to multiply exponentially. More the available serum iron, more the fungus thrives. High blood sugars, acidotic environment make the phagocytes lethargic and slow. Phagocytes are the frontline policing warriors, who are supposed to immediately reach the site of invasion, attack the invader and destroy the fungus by engulfing it.

In covid infected, the blood vessels are already clogged by thrombus; hence the phagocytes and other elements are unable to reach the fungus which by now has firmly gained foothold into the nasal passage. As there is not enough resistance offered by the body, it starts eating the surrounding tissue spreading to the orbit, sinuses and at times to brain structures which are in contiguity. With best of antifungals it remains difficult to control because they are unable to reach the infected site as the blood vessels are clogged.

As the pandemic unfolds we are finding more holes in our defenses than in Swiss cheese. This time it looks like science has bitten off more than it can chew. 

Credits: Brig.Dr. Shashivadhanan MS, DNB(Gen Surgery), MCh, DNB(Neurosurgery),  MNAMS, FIGASS (Copenhagen),  FICS(Chicago), FIMSA Professor(Surg & NeuroSurg)

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